Hypertension is a common disorder characterized by a sustained elevation
of systolic arterial pressure (top number) of 140 mm Hg or higher, or a
diastolic arterial pressure (bottom number) of 90 mm Hg or greater, or both.
Hypertension is divided into two categories: essential (or primary) hypertension
and secondary hypertension. Etiology: Research has shown that hypernatremia
(elevated serum sodium) increases the volume of blood, which raises blood
pressure. Primary hypertension may also develop from alterations in other bosy
chemicals. For some clients who respond to stress at a higher degree,
hypertension may be related to a higher degree, hypertension may be related to a
higher release of catecholamines, such as epinephrine and norepinephrine, which
elevates blood pressure. Others feel that hypertension may be caused by a
deficiency of natriuretic factor (a hormone produced by the heart) causing
arteries to remain in a state of sustained vasoconstriction. Other causes may
include: - Adrenal tumors - Acute pain or stress - Alcohol withdrawal -
Amphetamines - Birth Control pills - Cardiovascular disease - Cushing's disease
- Genetic factors - Hyperthyroidism - Kidney failure Pathophysiology: Regardless
of whether a person has primary or secondary hypertension, the same types of
organ damage and complications occur. Hypertension causes the heart to pump
against greater resistance, increasing its workload. The size of the heart
muscle increases from the outer layer of the epicardium to the inner layer of
the endocardium. Besides the direct effects on the heart, high blood pressure
accelerates atherosclerosis and can cause other serious complications. Damage to
many organs of the body can also occur, such as to the eyes, heart, brain, and
kidneys. Blood vessels may rupture under the strain of high pressure. Tiny
arteries in the retina may hemorrhage, possibly resulting in blindness. A blood
vessel may hemorrhage in the brain causing cerebrovascular problems. Renal
failure may also result from decreased circulation to the kidneys. Signs &
Symptoms: Clients may not have symptoms since the onset of hypertension, often
called "the silent killer", is gradual. In some cases, hypertension is
not diagnosed until the person experiences a major complication. Some minor
symptoms may include: - Consistent Bp readings of 140/90 or higher - Headache -
Flushed face - Pulsing sensation in the head - Dizziness - Fatigue - Insomnia -
Nervousness The most obvious finding during a physical assessment is a sustained
elevation of one or both blood pressure measurements. The pulse may feel
bounding from the force of ventricular contraction. Hypertensive patients may be
overweight and may possibly have peripheral edema. An opthalmic examination may
reveal vascular changes in the eyes, retinal hemorrhages, or a bulging optic
disk. Diagnosis: A patient may be experiencing hypertension when the blood
pressure is consistently, but not always, higher than normal. The blood pressure
should be checked at different times and different days to confirm that the
readings are consistent. In addition to repeating the blood pressure
measurements, an evaluation for hypertension by a medical doctor may include: -
a physical examination, including an accurate medical history - lab blood work
(may include kidney profile, thyroid profile, and adrenal gland function) -
urinalysis - electrocardiogram - chest x-ray Medical Treatment: Currently there
is no cure for hypertension that is not secondary to another disease or
condition. However, there are successful treatments that do control the effects
of the hypertension. Initial management of hypertension depends on the degree of
pressure elevation. Mild elevation may be treatable with nonpharmacologic
therapy, which may include rest, reduction of stress, counseling, weight loss,
reduction of sodium in the diet, limiting the drinking of alcohol and the
elimination of smoking tobacco products. If cholesterol and triglyceride levels
are increased, a diet low in saturated fats may be recommended. Depending on the
clients response to nonpharmacologic therapy, one of several antihypertensive
drugs may be prescribed. There are many different types of drugs with proven
track records in the control of hypertension, such as Apresoline and Brodipine.
Choice of treatment depends upon the patient's age, race, and medical history.
Prognosis: If untreated, hypertension places a patient at high risk for the
development of a disabling or fatal disease. Thorough evaluation by a medical
doctor will start a patient on a successful treatment program that will include
patient education for a healthier lifestyle. Following the recommended treatment
program will enable the patient to enjoy a more active life.